Completion of this form is required for any student who wishes to leave campus for an overnight stay or extended leave during the course of their enrollment. Multiple submissions do not have to be made for consecutive nights, but there must be a submission for each individual trip or stay. FORMS MUST BE SUBMITTED AT LEAST 72 HOURS PRIOR TO INTENDED DEPARTURE. STUDENTS WILL RECEIVE A CONFIRMATION EMAIL 24-48 HOURS PRIOR TO DEPARTURE. STUDENTS SHOULD BE CHECKING THEIR EMAIL.

* Required

Name of Student *

Provide Full Name

Your answer

Student Cell Phone Number *

Your answer

Student Personal Email Address (not SU email) *

Your answer

Summer College Program *

List the program of enrollment

Your answer

Room Number

Assigned Room Number in Residence Hall

Your answer

Date & Time of Departure *

Your answer

Date & Time of Return *

Your answer

Reason for Departure *

Please provide a brief explanation so the Summer College Staff can confirm with your guardian(s).

Your answer

Guardian Contact Information *

Please provide the name and phone number of your guardian(s), so staff can confirm your leave from campus.